Preoperative oral carbohydrate loading versus fasting in patients undergoing major abdominal surgery: a randomized controlled study

Objectives: Insulin resistance and the stress hormones released by surgery accompany a catabolic response. We intended to validate the impact of preoperative carbohydrate (CHO) loading on the metabolic and inflammatory subsequence of elective major abdominal surgery. Methodology: This prospective randomized trial was carried out on 54 participants scheduled for elective major abdominal surgery. Patients were randomly assigned to two equal groups: the FAST group followed typical fasting protocols. and received a placebo drink (200 mL of clear water) two hours before the procedure, while the CHO group received a CHO drink at least two hours before the anesthesia induction. Results: The major outcomes were a statistically significant decrease in muscle mass measured 5 days postoperatively in the FAST group compared to the CHO group, HOMA- IR, and GPS that increased significantly in the FAST group postoperatively compared to the baseline preoperatively. There was a decreased time to independent ambulation and duration of hospitalization in the CHO group than in the FAST group. Conclusions: Preoperative oral carbohydrate loading significantly mitigates postoperative insulin resistance, maintains better muscle mass, and improves subjective well-being in cases experiencing major abdominal surgery compared to traditional fasting. Keywords: Oral Carbohydrate Loading, Fasting, Major Abdominal Surgery, Glasgow Prognostic Score, Bioelectrical Impedance Analysis Citation: Abo-Omar EMTS, Abo-Elnasr LM, Soliman SM, Taysser Mahmoud Ahmad Abdalraheem TMA, Mohamed Yousef NK, Preoperative oral carbohydrate loading versus fasting in patients undergoing major abdominal surgery: a randomized controlled study. Anaesth. pain intensive care 2025;29(1):91-98. DOI: 10.35975/apic.v29i1.2668 Received: October 16, 2024; Reviewed: October 28, 2024; Accepted: October 30, 2024